Although abdominoplasty is one of the oldest procedures in plastic surgery, new approaches like high lateral tension abdominoplasty have refined the technique and its aesthetic outcomes. Still, problems remain like the length of the procedure, difficulties of dissection of long flaps, lack of elasticity in the flaps due to previous surgery, scars at the surgical site, unfavorable aesthetic outcomes, and variable challenges during the postoperative period, like wound healing and pain. Particularly, secondary abdominal surgery remains a technical challenge, from decision to application.